Korean J Obstet Gynecol.  2011 Aug;54(8):454-458. 10.5468/KJOG.2011.54.8.454.

Efficacy and safety of uterosacral ligament vaginal vault suspension and levator myorrhaphy for pelvic organ prolapse

Affiliations
  • 1Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea. yooe7@khu.ac.kr

Abstract


OBJECTIVE
To evaluate the efficacy in the anatomical and functional outcome and the safety of uterosacral vaginal vault suspension and levator myorrhaphy surgery performed during vaginal hysterectomy for pelvic organ prolapse.
METHODS
A retrospective analysis was performed on the medical records of twenty-eight patients who underwent uterosacral vaginal vault suspension and levator myorrhaphy with the vaginal hysterectomy for pelvic organ prolapse. Anatomical outcomes based on pelvic organ prolapse quantification (POP-Q) system and urinary, bowel and sexual symptoms from Korean version of short form of pelvic floor distress inventory and pelvic organ prolapse and incontinence sexual questionnaire were assessed pre- and postoperatively. They were followed up for minimum a year. The recurrence was defined as any points of POP-Q system to be stage II or greater.
RESULTS
A significant improvement of prolapse was observed from preoperative stage of III to postoperative stage of 0. The points of Ba, C, Bp were changed from 3.7 +/- 1.5, 2.5 +/- 1.2, -0.1 +/- 2.5 to -2.7 +/- 0.4, -6.2 +/- 0.9, -2.1 +/- 2.3. Intra-operative complications were 2 cases of ureter injury while stitching from uterosacral vaginal vault suspension surgery. Post-operative complications were 2 cases of urinary tract infection, 3 cases of voiding dysfunction and a case of urinary incontinence. No patient required reoperation for recurrent prolapse and urinary incontinence.
CONCLUSION
Based on our operational result, uterosacral vaginal vault suspension and levator myorrhaphy surgery seem to provide safe and effective outcomes.

Keyword

Pelvic organ prolapsed; Reconstructive surgical procedures; Vagina

MeSH Terms

Female
Humans
Hysterectomy, Vaginal
Ligaments
Medical Records
Pelvic Floor
Pelvic Organ Prolapse
Prolapse
Surveys and Questionnaire
Reconstructive Surgical Procedures
Recurrence
Reoperation
Retrospective Studies
Ureter
Urinary Incontinence
Urinary Tract Infections
Vagina

Reference

1. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997. 89:501–506.
2. Shull BL. Pelvic organ prolapse: anterior, superior, and posterior vaginal segment defects. Am J Obstet Gynecol. 1999. 181:6–11.
3. Lemack GE, Zimmern PE, Blander DS. The levator myorraphy repair for vaginal vault prolapse. Urology. 2000. 56:50–54.
4. Miller NF. A new method of correcting complete eversion of the vagina with and without complete prolapse; report of 2 cases. Surg Gynecol Obstet. 1927. 44:550–555.
5. McCall ML. Posterior culdeplasty surgical correction of enterocele during vaginal hysterectomy a preliminary report. Obstet Gynecol. 1957. 10:595–602.
6. Shull BL, Bachofen C, Coates KW, Kuehl TJ. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol. 2000. 183:1365–1373.
7. Barber MD, Visco AG, Weidner AC, Amundsen CL, Bump RC. Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for treatment of pelvic organ prolapse. Am J Obstet Gynecol. 2000. 183:1402–1410.
8. Karram M, Goldwasser S, Kleeman S, Steele A, Vassallo B, Walsh P. High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse. Am J Obstet Gynecol. 2001. 185:1339–1342.
9. Buller JL, Thompson JR, Cundiff GW, Krueger Sullivan L, Schön Ybarra MA, Bent AE. Uterosacral ligament: description of anatomic relationships to optimize surgical safety. Obstet Gynecol. 2001. 97:873–879.
10. Gustilo-Ashby AM, Jelovsek JE, Barber MD, Yoo EH, Paraiso MF, Walters MD. The incidence of ureteral obstruction and the value of intraoperative cystoscopy during vaginal surgery for pelvic organ prolapse. Am J Obstet Gynecol. 2006. 194:1478–1485.
11. Silva WA, Pauls RN, Segal JL, Rooney CM, Kleeman SD, Karram MM. Uterosacral ligament vault suspension: five-year outcomes. Obstet Gynecol. 2006. 108:255–263.
12. Wheeler TL 2nd, Gerten KA, Richter HE, Duke AG, Varner RE. Outcomes of vaginal vault prolapse repair with a high uterosacral suspension procedure utilizing bilateral single sutures. Int Urogynecol J Pelvic Floor Dysfunct. 2007. 18:1207–1213.
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